How Do We Diagnose Andropause?

Generally, only a blood test can definitively diagnose andropause.
After the age of 50, the average testosterone
level decreases at a rate of approximately one percent per year.
However, if only absolute testosterone levels are evaluated, many patients
with andropause will be missed. There may be an increased level of sex
hormone-binding globulin that binds the testosterone and makes less
of it available to the tissues. Also, as men get older, the daily rhythm
to the secretion of testosterone changes. Younger men have higher testosterone
in the morning, which then decreases as the day wears on. In older men,
this curve is flattened, leading to steady low
levels of testosterone throughout a 24-hour period.

Here are some issues regarding testosterone that are important to remember:

It is not yet known what level of serum testosterone defines a deficiency
in older men. Generally, it is accepted that two standard deviations
below the normal values for young men is considered abnormal.

A man may have large variations in his serum testosterone levels
over time. Since he may have normal testosterone levels one day and
have decreased testosterone levels the next, it is important to look
at hormone levels over a period of time.

In older men, affected organs may respond differently to androgens.

Not all men will need the same level of testosterone to maintain proper
function of their brain, bone, prostate, or muscle cells. Therefore,
it would be incorrect to say that there is one standard level of testosterone
that should be achieved by all men. Rather, the patient and the physician
work together to find the level of testosterone that is most effective
for the particular patient.

There remains significant controversy as to how best to measure testosterone
levels and diagnose andropause. It is well accepted that if total testosterone
is less than 200 ng/dl, a man will be considered as having a low testosterone
level. If his total testosterone is greater than 600 ng/dl, low testosterone
may be ruled out.

The analog-free testosterone method is the most commonly
used test by most large commercial labs in the United States, but it
is not considered a very accurate way of measuring testosterone. The
best measurement of hormonal status is either free testosterone or bioavailable
testosterone. These measurements may only be available through specialty
laboratories.

It is important to remember that there is significant variation in the
recommendations of what tests should be used in order to establish a
biochemical diagnosis of andropause. However, it is widely accepted
that the blood work should be done in the morning before ten o'clock
to capture the potential peak values.

How Do We Diagnose Andropause?

Generally, only a blood test can definitively diagnose andropause.
After the age of 50, the average testosterone
level decreases at a rate of approximately one percent per year.
However, if only absolute testosterone levels are evaluated, many patients
with andropause will be missed. There may be an increased level of sex
hormone-binding globulin that binds the testosterone and makes less
of it available to the tissues. Also, as men get older, the daily rhythm
to the secretion of testosterone changes. Younger men have higher testosterone
in the morning, which then decreases as the day wears on. In older men,
this curve is flattened, leading to steady low
levels of testosterone throughout a 24-hour period.

Here are some issues regarding testosterone that are important to remember:

It is not yet known what level of serum testosterone defines a deficiency
in older men. Generally, it is accepted that two standard deviations
below the normal values for young men is considered abnormal.

A man may have large variations in his serum testosterone levels
over time. Since he may have normal testosterone levels one day and
have decreased testosterone levels the next, it is important to look
at hormone levels over a period of time.

In older men, affected organs may respond differently to androgens.

Not all men will need the same level of testosterone to maintain proper
function of their brain, bone, prostate, or muscle cells. Therefore,
it would be incorrect to say that there is one standard level of testosterone
that should be achieved by all men. Rather, the patient and the physician
work together to find the level of testosterone that is most effective
for the particular patient.

There remains significant controversy as to how best to measure testosterone
levels and diagnose andropause. It is well accepted that if total testosterone
is less than 200 ng/dl, a man will be considered as having a low testosterone
level. If his total testosterone is greater than 600 ng/dl, low testosterone
may be ruled out.

The analog-free testosterone method is the most commonly
used test by most large commercial labs in the United States, but it
is not considered a very accurate way of measuring testosterone. The
best measurement of hormonal status is either free testosterone or bioavailable
testosterone. These measurements may only be available through specialty
laboratories.

It is important to remember that there is significant variation in the
recommendations of what tests should be used in order to establish a
biochemical diagnosis of andropause. However, it is widely accepted
that the blood work should be done in the morning before ten o'clock
to capture the potential peak values.